05.18.11

Painful Side Effects of Antibiotics

Posted in Medication at 8:03 AM by Dr. Greathouse

Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population

Hall MM, Finnoff JT, Smith J
PMR.2011:3:132-142

Article Summary

Adverse musculoskeletal side effects have been well documented with the use of fluoroquinolone antiobiotics. In 2008, the US Food and Drug Administration (FDA) placed a black box warning, as well as further medication recommendations, on all fluoroquinolones due to the increased risk of developing tendinitis and/or tendon rupture.[1] A review of the current literature by Dr. Hall and colleagues discusses potential mechanisms of pathology, identifies risk factors, and proposes updated guidelines in the athletic population, which include:

Avoid fluoroquinolone use unless there is no alternative.

The coaching and athletic training staff should be made aware of the use.

Corticosteroids should not be utilized in conjunction with fluoroquinolones.

Consider concomitant magnesium and/or antioxidant use.

Training routines should be reduced in intensity and volume once antibiotics are started. A graduated return to full activity should be implemented so long as the patient remains asymptomatic after the antibiotic course is finished.

All athletic activity should be stopped if any adverse reactions are experienced.

The patient should be monitored for 1 month after completion of antibiotics.

The quinolones are a family of synthetic broad-spectrum antibiotics. The term quinolone(s) refers to potent synthetic chemotherapeutic antibacterials.[1][2]

Quinolones, in comparison to other antibiotic classes, have the highest risk of causing colonization with MRSA and Clostridium difficile. For this reason, a general avoidance of fluoroquinolones is recommended based on the available evidence and clinical guidelines.[6][7][8] The majority of quinolones in clinical use belong to the subset fluoroquinolones, which have a fluorine atom attached to the central ring system, typically at the 6-position or C-7 position.

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